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Controversial plans to bar hundreds of thousands of illegal immigrants and failed asylum seekers from all but emergency health services are being considered by the Home Office.Amid claims the move will place increased strains on hospitals and inflame community tensions, The Observer can reveal a joint Department of Health and Home Office review examining proposals to restrict free access to GPs' surgeries for failed asylum seekers and 'irregular migrants' is due to report in the new year.

The review was supposed to report last month but was delayed until December because of disagreements between the two departments. While the Home Office is pushing for further restrictions on health care provision, which it sees as a 'pull factor' for people coming to the country, the Department of Health is believed to have reservations about how they will work. As a result of the row, The Observer understands, the review, which follows three years of consultation, has been pushed back until January.Experts and MPs have expressed concerns at reports that the government has decided to introduce further restrictions on free healthcare which will affect almost 600,000 people.

According to the Institute for Public Policy Research (IPPR) think-tank, it is estimated there are up to 390,000 failed asylum seekers in the UK who are either unwilling or unable to return to their home countries and who would lose access to free healthcare provision if the government approves the plan. A further 200,000 migrants working in the UK on the black market would also be affected.

Currently everyone in the UK qualifies for free primary health care services - such as access to GPs. But asylum seekers were barred in 2004 from accessing free secondary health services, such as treatment in hospitals for HIV, amid concerns about the spread of so-called 'health tourism'- people travelling to this country to receive treatment.

At the time the restrictions were criticised by some migration experts who said there was no evidence to support claims many migrants travelled to the UK to seek treatment.

'Different hospitals developed different protocols and the system became confusing,' said Jill Rutter, senior research fellow at the IPPR.

Now, in what the government says is an attempt give clarity to the system, it is considering restricting free access to GPs' surgeries and mental health services for failed asylum seekers.

Experts warned the move would place greater pressures on A&E departments.

'This will increase community tensions,' Rutter said. 'What signals are going to be sent out if queues of asylum seekers are waiting at A&E departments because they can't register with a GP?'

And she said it could increase risks to public health. 'If you are unable to immunise people, it increases the risk of an outbreak in communicable diseases.' She added: 'The government is in danger of normalising what many people will see as a breach of human rights - someone's right to basic health care provision. The government is saying people who aren't entitled to healthcare should pay for it but asylum seekers are the very people who can't afford to pay for these services.'

Moyra Rushby of Medact, the organisation that provides health services for migrants, said: 'We are concerned that any further measures to restrict access to primary care will have profound impact on the health of an already vulnerable group of people. Potentially serious conditions such as asthma, normally diagnosed and treated in general practice effectively and at low cost, will be left untreated, becoming potentially life threatening.'

MPs have also expressed concerns at the direction in which the government is moving. Labour MP Neil Gerrard has raised an early day motion arguing against any further restrictions on free healthcare for asylum seekers. There will also be a meeting of MPs in parliament next week to highlight the issue.

A Home Office spokeswoman confirmed the joint review would now not be published until next year and said it had not decided whether to further restrict healthcare provision to illegal migrants and failed asylum seekers.

'The review is still under way and no definite proposals have yet been put forward,' the spokeswoman said.

Yeah - this is incredibly stupid. Anybody in goverment who thinks this is going to save ANY money is insane. They need to look at the cost of managing asthma in the community with monitoring by a GP and inhalers against the cost of an emergency situation - being treated with nebulisers in A+E and then being admitted into a hospital bed for a few days. Or the cost of an intensive care bed for somebody who's chucked up a load of blood because of an untreated ulcer... it's stupid financially, apart from the obvious human rights arguement.

At the end of the day, we need to be more effective in deporting failed asylum seekers, and extending aid and expertise to countries with worse healthcare systems. Instead we propose a system that will create an even more unequal society, whilst simultaneously stealing medical staff from developing countries and totally failing to control our own borders. And we have a SUPLUS of junior doctors in the UK....

it is something that is affecting many people where i live, including some friends of mine. it really is a dreadful situation and thankfully some people (such as leeds mp john battle) are trying to fight against it. i was speaking to mr battle last night at our vigil (which he spoke very finely at vis a vis the global being local) and he told me that the animosity in the uk is currently so bad (thanks to the likes of the daily mail) that the government is secretly providing 700 people with antiretrovirals but doesnt want to admit it because of fears of a public backlash. crazy. and obviously they are unlikely to do that for long.

to give an illustration of quite how marginalised these people are in our society and quite how awful their situation is i will tell you a little about on friend of mine. she is waiting to be deported back to zimbabwe, thanks to our lovely government claiming that it is a safe country in which she will face no danger and will be able to access arvs. yeah, right. her mother was one of the many people whose homes were bulldozed by mugabe last year and has been homeless since. her husband and most of her family have died of aids. her (hiv negative) cousin recently died during an only very minor operation because of how appallingly bad the 'healthcare' system is. and obviously we all know about the political situation and the food shortage. this lady also has liver problems. she cannot access any of the healthcare she needs and is not entitled to any support as her final asylum appeal was refused. the dreadful stigma within her own community means that neither her nor any of the others like her attended our vigil last night because they were too scared that someone might see them and realise that they were positive. this woman has nothing. she wants to work but isnt allowed. she once sat in my house and asked me what she should do - be returned to almost certain death in zimbabwe or 'disappear' here. how on earth could i ever advise her on a decision like that? a decision which i am lucky enough that i will never have to take.

"I'm not keen on the idea of the afterlife - not without knowing who else will be there and what the entertainment will be. Personally I'd rather just take a rest." Oscar Berger, PWA: Looking AIDS in the Face, 1996. RIP.

Itís tempting to cloud the issue and get bogged down by individual cases and I donít really want to here, but where highly questionable decisions have been made by the authorities in regard to someoneís immigration status (for example the case of the Zimbabwean woman quoted by englishgirl), no one with any heart could fail to have sympathy. But in that particular case, the real question isnít about whether or not a failed asylum seeker should be able to access UK healthcare, itís about the decision to refuse asylum in the first place. Isnít the solution to apply pressure on the Government to change its definition of Zimbabwe as a safe place, which would then allow that individual to stay here legally?

Unfortunately, sympathy eventually has to give ground to common sense. There are probably millions of deserving cases in the world who, one could argue, should be entitled to asylum and free healthcare and in an ideal world, wouldnít it be wonderful if we could provide it? But letís get real for a moment; we live on an island that does not have rubber sides; there is a limit to the number of immigrants we can comfortably absorb. In addition, the resources of our NHS are finite and have to be paid for by UK taxpayers. The UK simply wouldnít be able to afford it.

I canít help wondering how many opponents of this proposed change would still feel so strongly when faced with increased delays in getting NHS treatment due to the sheer numbers ahead of them in the queue; or who have to shoulder a massive increase in personal taxation or NI contributions in order to pay for NHS treatment for people who have never contributed into the system and really have no right to be here? In the UK our population is 60-odd million, about 70,000 of whom are HIV positive. There are about 40 million people worldwide who are HIV positive; to send out the message that if you are ill you can come to Britain and, irrespective of your immigration status, receive free treatment would be catastrophic for our already creaking healthcare system. As they say in the States, you do the math...

My partner and I looked into the possibility retiring early to Spain, but it turns out that if we go there before we reach retirement age (65), we will not be eligible for free healthcare from the Spanish system after the initial two years. Why? Because we havenít contributed into it. Furthermore, after the same two years we would no longer be entitled to NHS treatment from the UK either. Why? Because weíre no longer classed as UK residents and would have ceased paying UK National Insurance contributions. Until we reach 65 we would effectively drop into a black hole in which we would have to pay for our own treatment. And this is from a system that we have paid into all our lives.

There are many countries in the world that do not even have an NHS or equivalent. If for example I was to visit a non-EU country such as the US (travel ban aside) and fell ill or had an accident, I would probably be expected to cough up for any medical expenses I incurred. Thatís why I have to (and am happy to) take out travel insurance. Anyone who is seriously ill when they arrive in the UK, or who falls ill or needs emergency attention while they are here, should receive treatment; to do otherwise would clearly be inhumane. Also, anyone who has applied for political asylum and whose case is still under review should also be treated. However once an asylum application has failed I see no reason why the NHS should be expected to continue to treat an individual who may have a chronic condition but that is not immediately life threatening. I would not expect (nor probably be given) the same from a foreign country. Furthermore the individual should be deported without delay and not allowed to simply melt back into our society as appears to be currently the case.

I think Matt Mee had it right; we shouldnít be finding ourselves in this dreadful position in the first place. We need to tighten our borders so that it is almost impossible for people to arrive here illegally and we need to review and speed up our asylum process so that applicants can receive a swifter and fairer decision. In the specific case of HIV, we have to try to reduce the pressure on people to want to come here for treatment in the first place, by either increasing the aid that we and other governments give to poorer countries, and by ensuring that what aid we do give is more effectively targeted and not tied up with ridiculous strings attached (ABC, for example). And we need to review our acceptance criteria for political asylum by reassessing the threat to an individual from whatever regime may be in power in their particular country.

No doubt this post will provoke some people; whenever arguments like this are raised, there are always those quick to shout ďxenophobia,Ē or worse. But somebody, somewhere, has to take a step back and look at the big picture without getting distracted by individual cases. However humanitarian we may be feeling at the time, the books still have to be balanced. There are many poor places in the world that cannot afford to treat their sick and elderly but we need to tackle this at source. Much though we might want to, we simply canít invite them all here.

I think the arguments that the entire (poor) world will want to immigrate to the UK and that the UK borders (and immigration practices) should be strengthened first is a bit of a red herring (and probably snow balling).

With regards to the (600,000) individuals who are already in the country, I think it is counterproductive from a public health concern to restrict their access to primary health-care (do you really want a certain proportion of the community walking around with untreated TB, HIV, HBV, HCV, etc..). And from an economic perspective, it makes no sense, as access to primary care is much more cost effective than emergency care, which would still be covered.

One of the first principles of problem solving is not to let the problem get any worse. Strengthening the border controls would prevent illegal immigrants from entering the UK in the first place, and tightening up the asylum process would reduce the number of failed asylum seekers, thereby negating the problem being discussed here i.e. their entitlement to free NHS healthcare.

Naturally all of the world's sick will not want to come here, nor have the ability to do so, but it's sometimes necessary to consider the extremes of an argument to make a point. If even less than one percent did, we would still have a huge problem on our hands.

Point taken about emergency care being more expensive than primary care, however no care at all is even more cost effective. We could then divert that saving to providing more aid where it's needed most i.e. in the country of origin, not when it lands on our doorstep.

Given my penchant for extreme scenarios, consider this one: we have a UK citizen who has lived here all his/her life, paid tax and national insurance to the state for 50-odd years and at the age of 70 needs a hip replacement. We also have an illegal economic migrant who has landed here from a safe country, has contributed nothing to the state and who presents with non symptomatic HIV. Both need treatment, but there's only enough money in the pot to pay for one of them. Who are you going to treat?

Let's be absolutely clear here - I am not talking about immigrants who have gone through the correct immigration channels and who have gained residential status, nor to those granted political asylum due to fear of persecution or death in their homeland. I'm talking about individuals who have no legal right to be here, who are not in any danger of persecutuon in their country of origin and do not have any immediately life-threatening medical conditions. Do I want these people walking around with TB, HIV, HBV etc? No, I don't. I don't want them here at all.

Same problem here, anyone waiting for asylum (always takes years, I even know one poz lady who waited 14 years) isn't allowed to work. If they fail, obviously not allowed to work and await deportation. Dutch government does provide HIV care though as a humanitarian act. This doesn't stop them from deporting people eventually back to countries where they say treatment is available. Like Uganda.

Carl, I think there is a difference btw wanting to take early retirement and expecting free healthcare & this situation. But no one is stopping you from moving to Spain, working there for a while and earning your rights. Consider that you want to immigrate to enjoy some sunshine and a quality of life; these people immigrate as a last resort. I immigrated too so maybe I am biased. I was not even remotely close to the desperation of the kind Nikki mentions, but it wasn't just for fun either.

Logged

"If you keep one foot in yesterday, and one in tomorrow, you piss all over today". Betty Tacy

Entirely agree with BassMan - while I agree the proposed policy is short-sighted and unlikely to achieve savings, the real issue is that the UK (and to a lesser extent some of the other countries in the EU) really need to sort themselves out with regard to the chaos that is asylum and economic immigration. It needs to be transparent, planned, fair and applications (including those that are rejected) dealt with promptly.

it's sometimes necessary to consider the extremes of an argument to make a point

Ö and unfortunately extremes are far better suited to making bigots than they are to making valid points.

This whole idea is so stupidly short-sighted that it beggars belief Ö and what makes it worse is that it actually costs far more to deport than it does to leave these poor people with access to treatment.

As vokz quite rightly suggests, it is dangerously easy for people who hold extreme (and often unpleasant) views to use arguments such as mine to further their own equally unpleasant ends and I think all too often this discourages real debate about sensitive issues out of fear of being labelled a racist. Let me make this perfectly clear: that is not what I am about.

I have no problem whatsoever with immigrants who use the proper channels, or those who are granted asylum, from accessing the UK healthcare system providing they are then prepared to work and thereby contribute towards their maintenance as we all have to. Nor do I have a problem with anyone whose application is pending from accessing healthcare or, for that matter, being able to work (and thereby contribute to the state) while they are awaiting their decision. I also do not believe that HIV+ status alone should be any obstacle to gaining UK citizenship as it is in many other countries.

My comments about emigrating to Spain were made to illustrate the point that even within the EU you cannot simply go to another country and expect it to support your healthcare needs without working. You have to contribute into the system in order to take out of the system. If I was to retire here early I would still be eligible for NHS treatment, whereas if I move to another EU country I would not, even though I have paid into the UK system all my life and even though reciprocal arrangements for healthcare are supposed to be available within EU member states.

To clarify once more, in case anyone has any doubts, I am talking about illegal immigrants and failed asylum seekers only. I agree that these people need help but it needs to be provided through the most appropriate and effective methods at source and not on the basis of a free handout in the UK.

(1) because most tax for the NHS is paid for by companies who get rich off the labour and assets of poor countries and have done for generations

(2) it's free at A&E, which is where ill people will end up

(3) it's a few people who will need healthcare beyond the odd GP visit, especially for eg TB -- I really don't want people walking around with untreated TB -- and as for HIV, pragmatically speaking, not high principal but good public health, cos otherwise see (2) and (4)

(4) we will prob pay for the expensive bits eg HIV treatment and care out of the Dept for International Development budget if not from the NHS

(5) "health tourism" as a concept is, frankly, ridiculous. Ill people don't travel, well people travel for work, and I would like to see eg London work for a day without the legal and illegal immigrant labour, so major and expensive health burden, not I think.

Better/fairer/tighter immigration system is a red herring for me, either you believe necessary health care is a right, like food, water and shelter, or you don't. It is a moral question: is it right people in detention centres awaiting deportation receive sub-standard/no psychiatric care when in the grip of a psychosis, or end up dying of pneumonia because the bod thought it was "just a cold" or worse "Who cares, you're going home to die"? The answer is no.

That there are many "failed" ie rejected asylum seekers running around the villages of East Anglia and the like is nothing to do with the principles of health care in a rich ex-colonial country, more the ineptitude of the private contractors paid by public funds to do, or not do, the job of removal.

That said, I genuinely do not think that fear of being labelled a racist would stop most people from speaking out on matters like this .. but, the claim that it does silence an imaginary hushed majority, is an argument that is frequently used by racists to explain why they donít have more vocal support than they do.

Personally, I am more inclined to believe that people are silenced by the inner voice screaming ďthis is just so wrongĒ .. and that this is why there isnít a more vocal debate.

The argument about what rules are enforced elsewhere in Europe (or anywhere else in the world) is to me a complete irrelevance .. and also somewhat flawed, in that reciprocal arrangements for people taking up residency in other EU countries are designed to ensure that you get the same treatment that a citizen of that country would get (not the same treatment that you would get here in the UK).

If I go to live and work in Denmark, I wouldnít expect to get non-emergency treatment free at the point of delivery. I would expect to pay for it and claim the costs back through the national medical insurance scheme .. just as a resident citizen of that country has to do.

What is more important to me is that we reflect core values of our society (ĎBritishnessí if you like) through the NHS. For me that means offering universal free healthcare at the point of delivery to EVERYONE living in this country.

Now, if we are too incompetent to manage our own immigration and deportation policies effectively, then we should sort that out .. but please leave the NHS and the delivery of healthcare out of that argument.

From an idealogical viewpoint I'm sure we can all agree that it ought to be a basic human right to receive whatever healthcare you need free of charge; to see it denied to people does feel wrong. But if we could all have whatever we needed whenever we needed it and didn't have to worry about who was providing it then the world would be a much better place than it is; sadly, that's not the case. We have to be pragmatic and accept that we can't and shouldn't be expected to provide resources to treat anyone who comes here illegally.

Of course it can never be right that people awaiting deportation should receive substandard care of any description, but it can also never be right that they end up languishing for months on end in a detention centre either. That's why we need to speed up and tighten the immigration and deportation policies so they don't end up in that mess in the first place, and why we simultaneously need to do more to provide foreign aid and ensure that it is correctly targeted. Again I stress that I'm talking about illegal immigrants; if people need or want to come here so badly, then why don't they do it through the proper channels? To get back to the core of the issue, if you are an illegal immigrant in a country I do not see what is so morally repugnant about the idea that you are not entitled to access that country's resources.

I have to disagree that many people feel uncomfortable speaking out on sensitive race-related issues but let's not get sidetracked by that debate. The title of this thread is Failed asylum seekers & migrants face NHS ban therefore it's perfectly valid to discuss the NHS and delivery of healthcare in the context of immigration and deportation policies - surely that's what we're discussing here?

The title of this thread is Failed asylum seekers & migrants face NHS ban therefore it's perfectly valid to discuss the NHS and delivery of healthcare in the context of immigration and deportation policies - surely that's what we're discussing here?

No-one is saying we canít discuss it. We are putting forward our reasons for believing that it is wrong, inhumane, short-sighted, morally repugnant and (in some cases) illegal for one of the richest countries in the world to be considering withdrawing healthcare from people who are, for the most part, contributing to the economy of the country.

I believe, indeed, that overemphasis on the purely intellectual attitude, often directed solely to the practical and factual, in our education, has led directly to the impairment of ethical values.-Albert Einstein

I have no practical advice or suggestions for the workings of government and the financing of health care programs, but as a citizen not involved in the government, I don't believe that is a requirement for having practical advice and suggestions about ethical treatment of people.

Though for those who require this stay grounded in the practical, may I suggest that denying medical care to anyone only moves the financial burden from an area that can be tracked and understood (and dealt with) to less conspicuous and less easily track areas - areas that sometimes cost significantly more to society in general.

I still say the wider discussion on immigration is a red herring, designed to get us to argue/debate the merits of tighter immigration policy rather than discussing whether we believe all residents have a right to primary care and/or whether providing that right is beneficial to the wider community or public finances. No matter how competently immigration is enforced, you will have illegal immigration and/or pending asylum cases/deportations.

I think I have 2 personal involvements in this. One as a person who knows people in the asylum system, specifically poz people, I have a lot of sympathy and fear for them & what they have endured and continue to endure. That's not something anyone would want to go through.

The second involvement is selfishness. Is I think, as long as "illegals" are covered and taken care of, we will be quite well taken care of. Israel for example treats refugees (from Iraq, Sudan, Burma, and other countries) much worse than EU countries. It also treats people with HIV and chronic patients in general much worse than the EU. Countries like Eygpt, which treat refugees by shooting them dead when they try to cross the border to Israel, are not somewhere anyone can afford to be sick with anything, let alone HIV, unless they are very wealthy. So all in all it is much better to live somewhere that takes care of the weak. There is always a food chain, and it's always best not to stay too close to the bottom.

Logged

"If you keep one foot in yesterday, and one in tomorrow, you piss all over today". Betty Tacy

Now, if we are too incompetent to manage our own immigration and deportation policies effectively, then we should sort that out .. but please leave the NHS and the delivery of healthcare out of that argument.

No-one is saying we canít discuss it. We are putting forward our reasons for believing that it is wrong, inhumane, short-sighted, morally repugnant and (in some cases) illegal for one of the richest countries in the world to be considering withdrawing healthcare from people who are, for the most part, contributing to the economy of the country.

Either we can discuss it, or leave it out of the argument - which way do you want it? And we're not talking about those who are "for the most part" contributing to the economy. If they're contributing to the economy, fine, but in that case, why are they here illegally? Come here legally, then there's no problem, surely?

Either we can discuss it, or leave it out of the argument - which way do you want it? And we're not talking about those who are "for the most part" contributing to the economy. If they're contributing to the economy, fine, but in that case, why are they here illegally? Come here legally, then there's no problem, isurely?

Either we can discuss it, or leave it out of the argument - which way do you want it? And we're not talking about those who are "for the most part" contributing to the economy. If they're contributing to the economy, fine, but in that case, why are they here illegally? Come here legally, then there's no problem, isurely?

As for the NHS business I didnít say you couldnít discuss it, so I really don't know where the "which way do you want it?" business is coming from Ö I was referring to the Home Office review examining proposals to restrict free access to GPs' surgeries and simply saying that the NHS is the wrong tool to tackle immigration issues (IF there are any .. and I donít actually happen to think we have a problem with immigration).

I still say the wider discussion on immigration is a red herring, designed to get us to argue/debate the merits of tighter immigration policy rather than discussing whether we believe all residents have a right to primary care and/or whether providing that right is beneficial to the wider community or public finances. No matter how competently immigration is enforced, you will have illegal immigration and/or pending asylum cases/deportations.

And we're not talking about those who are "for the most part" contributing to the economy. If they're contributing to the economy, fine, but in that case, why are they here illegally? Come here legally, then there's no problem, surely?

I am sorry, but I think you are wrong. We ARE talking about people who are contributing to the economy of this country. You donít have to be legal in order to contribute to the economy of the country .. hell, we even have illegals working for government departments (in fact, we even have illegals working at the Home Office, which is responsible for the enforcement of immigration laws).

You donít have to be legal in order to contribute to the economy of the country .. hell, we even have illegals working for government departments

Then let's just abolish all border controls and have done with it. All are welcome. After all, we already have 600,000 immigrants here. Or is it 800,000? Hang on, no, it's 1.1 million... and those are the ones we know about, according to the Government, which freely admits it doesn't know at all...

What, you think I owe a bigot like Melanie Phillips any respect?....As for the NHS business I didnt say you couldnt discuss it, so I really don't know where the "which way do you want it?" business is coming from

I don't think you owe her any respect, but by answering "Says who? Melanie Phillips?" to one of my comments I think many would be forgiven for thinking you were suggesting my views were similar to hers. I think I've set my stall out quite clearly in that respect; it is, as I said in an earlier post, very difficult to pass comment on anything related to race or immigration these days without attracting negative associations. And it's also hard to discuss anything if you have to "leave it out of the argument."

Clearly we have very different viewpoints and I suspect never the twain shall meet.

I don't think you owe her any respect, but by answering "Says who? Melanie Phillips?" to one of my comments I think many would be forgiven for thinking you were suggesting my views were similar to hers. I think I've set my stall out quite clearly in that respect; it is, as I said in an earlier post, very difficult to pass comment on anything related to race or immigration these days without attracting negative associations. And it's also hard to discuss anything if you have to "leave it out of the argument."

Indeed. Seemed to me too to be a pretty peculiar way to advance the argument.

That suits me fine. If there is a job here for people to do, then let them come and do it.

An amnesty for all illegals would actually make this country richer in every way possible ... and there would still be more than 500,000 job vacancies.

The vast majority of these people would be only too happy to pay taxes and play their part in society .. so why should selfishness and petty nationalistic considerations get in the way of that? It isnít even as if there is a single person in this country who can stand up and declare with any conviction they arenít themselves of immigrant stock.

The reason I asked if it was Melanie Phillips saying it was that you didn't actually say it was your opinion. You simply told us that we "have to be pragmatic and accept that we can't and shouldn't be expected to provide resources to treat anyone who comes here illegally" (when there is no "have to" about it) .. and it does also happen to sound very much like something dear old Smellanie would say.

What a fascinating approach to domestic policy. And as I have said ad nauseam I have no problem with anyone who "pays taxes and plays their part in society" providing they go through the proper channels.

Incidentally, I think it's generally accepted that unless a poster specifically quotes someone else, then anything they write has to be read as their opinion. If it sounds like someone else, then just maybe they have a point too. As my old grannie used to say, "even a blind pig finds a truffle occasionally."

And the red herring succeeded.... The debate is now about immigration policies, well immigrants in general.

*sigh*

Cliff, I see no herring, red or any other colour. The thread is about failed asylum seekers and their eligibility (or otherwise) for NHS treatment; what are failed asylum seekers if they're not immigrants? And in my humble opinion (in case there's any doubt) the argument can be equally applied to any illegal immigrant, not just failed asylum seekers.

means: "We can't be bothered to deport you, and we don't care if you die in the gutter somewhere. We just don't care."

To me that's not cricket. Not British. Not my cup of tea.

True, maybe a very few people try it on with the asylum thing, but, all that sneaking about under lorries with shrapnel in your legs from (British-made) mines, long sea trips in overcrowded boats stuck with the memories of your family chopped to pieces, or the imprint on your retina of your house burned and your husband/wife/parents beaten for holding a contrary political view, seems a long shot way to go on a holiday to get good health care and a falling apart high-rise flat with a view of the rain.

By definition, failed asylum seekers have gone through the proper channels. It seems right to me to provide healthcare while they remain.

I now bow out of this thread. Our history on refugees is not all that honorable, and on immigration so damn hypocritical -- every British Gvmt since the War (the biggie, the one with the 2 large nukes) has encouraged immigrant labour, otherwise the economy don't work, ask any farmer, ask any minicab company, and none have had the guts to say so or stick to their guns. Especially this one.

The Home Office: ministry with front the size of a mansion, and brains of a bungalow. Whatever the principles, practically speaking, if you want an A&E service that works, eg for when mum has a stroke or sommat, it's a dumb policy to deny anyone in the country health care, especially for mental health and communicable and infectious diseases.

What a fascinating approach to domestic policy. And as I have said ad nauseam I have no problem with anyone who "pays taxes and plays their part in society" providing they go through the proper channels.

I always love this argument. It's natural conclusion is that children (who are yet to pay taxes until they work), the unemployed and disabled should not be eligible treatment under the NHS. Ah yes, but there will be caveats, of course.

By definition, failed asylum seekers have gone through the proper channels. It seems right to me to provide healthcare while they remain.

Agreed, and I said as much in an earlier post. But I would also want to deport them as soon as their asylum application fails rather than have them stuck for months or years in limbo with neither resident status nor access to healthcare.

I always love this argument. It's natural conclusion is that children (who are yet to pay taxes until they work), the unemployed and disabled should not be eligible treatment under the NHS.

Children are too young to work but will eventually, the unemployed have (presumably) worked in the past and will (presumably) work again in the future and the disabled often cannot work through no fault of their own. But they all have one thing in common - British citizenship and therefore the right to live in the UK and access British healthcare. Enter the country legally and you're welcome to access our NHS system legally. What's wrong with that picture? Or am I missing something??

I can say no more on this subject now without repeating myself so like newt, I'm going to respectfully withdraw from the debate. It is, I fear, one that's not going to go quietly.

Ministers face a doctors' rebellion over plans to deny failed asylum-seekers the right to free health care while they are in Britain.

In an unprecedented move, 275 GPs have said they will defy any new law by carrying on freely treating refugees, many of whom are torture victims, children and pregnant women.

Under proposals by the Department of Health and the Home Office, a refugee who has lost a claim for asylum will also lose the right to see an NHS doctor. Medical experts want the Government to withdraw the "foolish" plan, which they claim would pose health risks for asylum-seekers and the public. In a letter sent to The Independent and The Lancet medical journal, they warn: "It is not in keeping with the ethics of our profession to refuse to see any person who may be ill, particularly pregnant women with complications, sick children or men crippled by torture. No one would want such a doctor for their GP."

Failed asylum-seekers are already denied free secondary care on the NHS and are entitled to see a GP at their surgery only if the doctor agrees. Since 2004, the Government has been consulting on proposals to remove this discretion, so that failed asylum-seekers would be entitled to free NHS care only in cases of emergency. A final decision is expected within weeks.

Dr Frank Arnold, of the Medical Health Network which has organised a petition against the idea, said: "The Hippocratic oath makes no mention of discriminating against groups of people who are the target of public hate campaigns or whom governments find politically inconvenient.

"To tell doctors who they can and cannot see on this basis will have unpleasant effects on the practise of medicine. Do you want to be struck off your doctor's list because you are overweight or have a condition which might be expensive to treat?"

Yesterday, the Government refused to reconsider its decision to deport a terminally ill cancer victim whose visa had expired. Ama Sumani, 39, was sent back to Ghana from Cardiff last week but cannot afford kidney dialysis to prolong her life. The Lancet called the decision "barbarism", but Lin Homer, the chief executive of the Border and Immigration Agency, told MPs Ms Sumani's case did not stand out from others.

She said: "If we altered our consideration, there would be many thousands who could come and make similar claims. The coherent application of policy and careful consideration of individual issues by caseworkers and the independent judicial process is better and fairer than a decision by me as chief executive or by the minister."

But refugee groups also criticised the plan to restrict NHS care. Donna Covey, the head of the Refugee Council, said: "We have already seen the devastating effect that restrictions on access to secondary healthcare has had on people whose asylum claims have been turned down Ė cancer sufferers being denied radiotherapy and an operation, pregnant women refused antenatal care then forced to give birth at home, victims of rape being denied treatment.

"Now the Government is considering stopping people from even seeing a doctor. The implications of this are quite frightening."

The doctors' note

The UK Government is imminently considering means to abolish the right of "failed" asylum seekers to primary health care through the National Health Service in Britain. 276 doctors registered to practise in the UK have (so far) signed a petition opposing the policy. The substance of the petition appears below

"This would impose serious health risks on [undocumented migrants] and on the general public. It would also interfere with our ability to carry out our duties as doctors. It is not in keeping with the ethics of our profession to refuse to see any person who may be ill, particularly pregnant women with complications, sick children or men crippled by torture. No one would want such a doctor for their GP.

"We call on the Government to retreat from this foolish proposal, which would prevent doctors from investigating, prescribing for, or referring such patients on the NHS.

"We pledge that, in the event this regulation comes into effect, we will: (a) continue to see and examine asylum-seekers and to advise them about their health needs, whatever their immigration status; (b) document their diagnoses and required clinical care; (c) with suitable anonymisation and consent, copy this documentation to the responsible ministers, [Members of Parliament] and the press; (d) inform the public of the human costs, to harness popular disgust at what is being ordered by the Government in their name; (e) campaign to speedily reverse these ill-advised policies."

"I'm not keen on the idea of the afterlife - not without knowing who else will be there and what the entertainment will be. Personally I'd rather just take a rest." Oscar Berger, PWA: Looking AIDS in the Face, 1996. RIP.

I think health care is a basic human right. Our systems are wealthy enough to absorb the costs. I like to believe that solidarity still stands a chance.

Nobody is suggesting that basic healthcare should be denied, just made less easy to access for those who are here illegally.

Obviously you've never tried to find N.H.S. dental treatment; been prescribed inferior drugs simply on the basis of lower cost; refused treatment because your local N.H.S. trust can't afford to pay for it; had to go into debt to pay for private treatment because the N.H.S. wait was too long and you couldn't stand the pain any more, or had to move house to a different part of the country simply to get appropriate treatment from a system that you've contributed to all your working life.

Iím with Bassman on this one.

Anybody who is in this country legally, whether Immigrant or Asylum Seeker going through the process of achieving legal immigrant status should be, and already is, given full access to the same free healthcare and welfare benefits as any British Citizen.

Those who are here illegally, or who have failed the asylum process should be deported immediately; any necessary emergency care can be given at holding centres prior to deportation, that way the need for access G.P.ís wouldnít arise.

An estimated figure of 600,000 people who are here illegally has already been mentioned, a very low estimate in my opinion. Most of these people have already passed through one or more Ďsafeí countries before arrival in Britain, if they were genuinely seeking refuge from some atrocity or threat in their country of origin, then surely the first safe place they arrived in would be the place where they claimed asylum rather than just a transitory safe house on their journey to Britain?

The simple fact is that Britain has a welfare and healthcare system that is far more easily accessible than any other country in Europe. Now I donít blame anybody for wanting to take full advantage of that but the costs are unsustainable without large increases in taxation to pay for it all.

The dentist situation may be an emotive issue; but, if you bother to read beyond the tabloid headlines, it has bugger all to do with a shortage of funding (or even a shortage of dentists).

The vast majority (98%) of people who are here illegally, or who have failed the asylum process, arenít deported immediately and arenít held in holding centres. Even if they turn themselves in for deportation, they arenít generally sent to a holding centre and arenít deported immediately. Even if we wanted to detain them in holding centres, we donít have the holding centre capacity.

Much as I am sure it suits a violin overture, the fact that you were once in pain and had to wait longer than you would have liked, really doesnít make the inhumane treatment of others right and fair. And if you think it does, then I pity you.

Unless you are going to make provision for these people, you are saying that - despite the fact that the vast majority of them are working and are a productive part of the UK economy - you (yes, I mean you personally) are quite happy to see them rot in a hell of your making.

Maybe it is time I renounced my UK citizenship, because that sort of attitude makes me sick to the core and leaves me wondering when neo-fascist blackshirts are going to be rallying on my local high street and erecting a bust of Oswald Mosley in front of the town hall.

What happens when they realise that denying basic care to this first easy tabloid target only actually saves (at best) a few tens of millions a year? I hope you have plenty of savings, because you are the next obvious target.

Donít for a moment think that someone hasnít already figured out that caring for the people living with HIV is costing the NHS more than £750 million a year .. and that, after all, they are only prolonging the inevitable. It isnít curing anyone, most of us caught it through our own fault, most of us cost far more in taxes than we contribute and the tabloids already think we are a menace to society Ė so why not get clever and win the popular vote by spending all that lovely lolly on people who have cancer and really deserve it?

In a few years time, if you are lucky and your wishes come true, they might even send you and all the other pesky pozzers away to die in one of those holding centres they built (because you demanded it) for all the illegal immigrants and failed asylum seekers (remember them? .. well they are long gone now and the centres are sat there idle).

Farfetched fiction? Well, if you care to check, parliament already has long enacted powers to detain people with AIDS and it was actually considered by the glorious Thatcher government, so donít be so sure it canít be considered again.

And before you say ďthat just isnít the British wayĒ, remember that we have just established that, according to your own morals, it is perfectly acceptable to lock away those elements which the popular press target as Ďundesirableí and to deny them all but very basic emergency care (which for you and I will probably amount to generous amounts of opiates Ė probably heroin, because we can confiscate oodles of that economically in Afghanistan - to ease our passage into the afterlife).

In the meantime, donít for a moment think that - even if you can afford the £16,000+ a year it costs the NHS to treat the average pozzer - you would get that equivalent care for a penny under £40,000 a year if you were going to the private market.

Donít believe me? Have a look around at how much some of our US brothers and sisters are billing through insurance and £40,000 a year actually starts to look like quite an attractive deal.

Donít like those prospects either? Well you can always go to Australia, or the USA, and overstay illegally (remember, you are poz and have bugger all chance of getting residency by any legal means), so letís hope for your sake that they arenít locking their Ďillegalsí away in holding centres and denying them all but basic emergency care.

Hell - if I were selfish Ė none of this would bother me, because I can afford to pay for my own treatment (and in a roundabout sort of a way already do). Can most people? Can you? Should I even care whether you can?

Flaws in my argument? Maybe, I donít profess to be an expert, either on the detailed inner workings of the N.H.S. or on immigration.

Fatal flaws though? I donít think so, but Iíll leave it to others to judge.

I had in mind the comments of both joemutt and LordBerners when I replied to this post, mainly joemuttís, ďour systems are wealthy enough to absorb the costsĒ and LordBernersí ďI for one would love to emigrate to the UK for medical care, were it possibleĒ.

The simple fact is that neither the N.H.S., nor any part of the welfare system can afford free and unfettered access to everybody and this goes for the systems in any other country not just the U.K. There is no such thing as free; everything has to be paid for even if, as in the case of the N.H.S. it is free to the end user it must still be funded somehow, hence, LordBerners, the high levels of taxation in this country. I was also making the point that even for those who contribute to funding those systems, I.E. the taxpaying citizens, the service is not all it might seem to be and is already showing signs of overload.

So.

The dentist issue is certainly an emotive one, especially for those with toothache for days or weeks on end, who canít afford private treatment or find an N.H.S. dentist to take them on. Now I can only guess at what the tabloids say on the issue Vokz and the reasons behind the shortage of dentists willing to work in the N.H.S. is irrelevant to this debate, but the fact is that the N.H.S. doesnít have enough of them. The fact is, that for those who rely on the N.H.S. for dental treatment the system is already inadequate. Just for the record Vokz I wasnít referring to myself here, Iíve paid Denplan insurance for over 20 years.

You also seem to have assumed that I was the one at some point in pain and having to wait for treatment, not so. But I do know someone who, about 18 months ago was prescribed a drug for a mild heart complaint. Despite there being newer and better drugs, and despite this particular one apparently having having well known side effects, the N.H.S. prescribes it simply because itís cheap. This lady went from an able bodied person to pain ridden arthritic cripple in just a few short weeks, just one of her new drugís well known side effects, could she get an alternative? Not on the N.H.S. she couldnít! I think that this is perfectly illustrative of an already overburdened system trying to cope within itís budgets by prescribing inferior treatment.

Still with me so far?

Your point about the 98% of these people not being deported immediately is really the whole crux of the matter. I canít vouch for the accuracy of your figure Vokz, but given the widely recognized incompetence of the British immigration service, I for one donít doubt it. I do doubt though your obviously incorrect statement that; ďthe vast majority are working and are a productive part of the U.K. economyĒ. If they are here illegally Vokz how did this ďvast majorityĒ come by the national insurance number which is necessary to contribute to the taxation system? And if they donít have one how are they contributing? Ah yes, back to the cheap mini-cabs, the ďI do it cheap for cashĒ builders and the Filipino cleaning ladies. In actual fact Vokz there are only a small minority who are able to pay regular taxation and they would have initially had to enter the country legally and then outstay their welcome.

You comment about my morals Vokz; is it really so wrong or selfish for me to support the view that a country should make life uncomfortable for lawbreakers or detain them? Letís be clear here Iím not espousing that we deny anybody medical treatment even if they are here illegally, just that they shouldnít find it so easily obtainable. And maybe Vokz you should question your own moral stance, if youíre going to encourage these people to stay here illegally where do you draw the line? Which other laws are they going to be allowed to break and who decides? And for how long do we allow them free access to the same benefits as those who pay for them; until the system collapses altogether perhaps?

As I have already said and you have agreed, a large proportion of these ďillegalsĒ are really economic migrants and not in genuine need of compassionate leave to stay here. They contribute nothing financially to the system from which you argue they should derive benefit and could easily return to their home country if they wished, so why should we make provision for them? Is it really so selfish of me to want an already groaning N.H.S. to prioritise those people who have a legal right to itís services and who pay for it through their taxes?

Your reply Vokz is sadly illustrative of the situation which seems to exist in Britain today; either youíre up for unfettered immigration or youíre a racist, a xenophobe or even a fascist neo or otherwise, and a selfish one to boot! The irony is that every time people like you spout such claptrap and deny reasoned and reasonable debate with those who can see that immigration controls are a necessity, you are feeding the very people whom you claim to despise. The likes of the B.N.P. grow ever stronger because of you.

For the record Vokz I am none of the above and I despise the B.N.P. and their ilk as much as you profess to do. Unlike many people, however, I have the sense to realise that despite the faults of the present situation, extremism in either direction is never the answer.

I personally would (1) prefer to get a cab at 2am in London/get served in a restaurant/have my hospitals cleaned (2) don;t really care about the cost cos it's de minimis (3) remember every time I visit the Tate gallery that it's there because of the wealth generated by slavery (but I acknowledge 3 is an unusually pereceptive analysis on my part)

I can't ever remember any restaurant closing because of a lack of staff.

Hospitals haven't been cleaned properly for at least 20 years and this is down to a lack of spending on sufficient numbers of cleaning staff not lack of people available to do it.

There is not a taxi or cab system in the world, in any town or city that could cope with moving enormous numbers of people in a short space of time. Yes it is nice to have lots of available cabs at peak times but, bearing in mind that most of those drivers are self employed, and the costs of running a cab are relatively high, they would have to have prohibitively expensive fares just to operate at those peak times.

If these people really are needed is there any reason why they have to be here illegally?

The fact that a lot of them are here illegaly and are not au-fait with the British lingo, custom and practice, means that they are frequently at the mercy of people like rogue landlords supplying them with sub-standard, expensive accommodation, they are also at the mercy of unscrupulous employers especially in cash businesses like mini-cabs.

Which could bring us quite nicely to (3), just a modern form of slavery really?

UK NHS heathcare is not free to anyone. It is however (mostly) free at the point of treatment. The exceptions include the so called health tourists.

There are 6.5billion people alive on the planet today. Forecasts say that will rise to over 8bn in 40 years time. Immigration and the impact it has on a country's health care and other systems is not going away.

A sense of humanity says a Dr should treat all. No If's or But's. The politician's and budget managers are paid by us to decide how we apply finite resources.

The debate is not about humanity - who can say "no" is an option. Very few.

The debate is financial and logistical. Does a policy to treat all thereby encourage more people to use that knowledge to travel to the uk - legally, illegally - in the hope of treatment? My common sense says it does.

Will the UK and other relatively wealthy countries lower/remove immigration controls and the related policies on health? No, they will become more pronounced and more draconian as the world continues to increase its population.

Personally, I don't buy the health tourists argument. I think people immigrate for numerous reasons (legal- job opportunity/requirements, love of a county, etc..) (illegal- to escape economic poverty, violence, wars, reunite with family members, etc.). I don't think people take the high risk and high cost to illegally immigrate to the UK, just because of (free) healthcare.

Look at the US, limited (free) healthcare is available for illegal immigrants (undocumented workers) or legal residents for that matter. That does nothing to prevent people from coming the US every year.

This ban on healthcare will not stop people from coming to the UK. But it will make sure that a lot of sick folks are walking around the community.

In terms of cost, the Daily Mail and the government would have you believe that all of the NHS' funding problems are due to immigrants. It's not. This is but a drop in the bucket.